Self-portraits of Lea Pilipow, nursing during the pandemic.

Image Credit: Lea Pilipow

B.C. front-line critical care nurse Lea Pilipow says she can see the fear in her patients suffering COVID-19 as they are intubated and placed on a ventilator.

Being placed on a ventilator is the last option for COVID-19 patients suffering severe breathing difficulties. 

“Before we intubate (patients) they are having the last conversation with me and the team,” Pilipow says. “Often I'm thinking this will be their last conversation for a few weeks, maybe even their last conversation."

It’s the harsh reality of working in an intensive care unit during the coronavirus pandemic.

While the majority of us just read the headlines and get mildly annoyed by the restrictions, the 38-year-old sees the chilling effects of COVID-19 in the patients she cares for every day.

“I'm witnessing their fear," she says.

As a front-line nurse working in the intensive care unit at Mills Memorial Hospital in Terrace, the coronavirus pandemic presents challenges that are out of the normal scope even for those used to working in the complex environment of one-on-one critical care.

It’s pushing Pilipow to the limits of both her professional and emotional life.

It’s provoking fear, stress, and anxiety.

“I frequently see flashbacks of my patients struggling to breathe,” she says.

That’s not something that’s ever really happened to her before. Emotionally, it is incredibly difficult, she says.

As a registered nurse who specializes in working in intensive care, she’s used to dealing with the sickest of the sickest people in hospital. From horrific car crashes to heart attacks, strokes and stabbings, Pilipow is no stranger to caring for those whose very existence is hanging by a thread.

However, caring for COVID patients is different. By its very name, the novel coronavirus is new.

The pandemic hasn’t panned out in the way most would think it may have. Back in March when the province, the country, and much of the world went into lockdown, the intensive care ward in Terrace stayed relatively quiet.

Prior to the fall, Pilipow said she’d only dealt with a couple of COVID cases. But then things changed.

“I really started to feel the stress of it in November, and the crisis of it," she says. "It's just gotten busier and busier.”

Now the only patients she cares for are COVID patients.

“It started to get overwhelming because we were seeing patients on ventilators for longer, and up until November we hadn’t seen patients this sick in our unit,” she says.

Another factor that is often overlooked is that no one had ever dealt with the coronavirus before.

“We had experience caring for patients with other respiratory conditions on a ventilator, but not specifically COVID,” Pilipow says. “So that made it stressful not having anybody to really turn to ask for help.”

That colleague that's been around for 30 years and seen every possible scenario imaginable just doesn’t exist.

"In some ways, I feel the anxiety like being a brand new nurse because it's like caring for something brand new," she said. "I just had to trust in the way that I care for my patients.”

When a person is hospitalized with COVID-19 they are first placed in an infectious disease ward. Hopefully, they then recover and head home. If things get worse they are transferred to the intensive care unit.

With loved ones kept out of the hospital, all communication with families is done by phone.

Pilipow said she puts calls on speakerphone and sometimes has access to an iPad so families can see their loved ones. "We make time for it," she adds.

The conversations are one way. It's impossible to talk when on a ventilator and other patients struggle to breathe and only find a few words.

The patients are also younger than imagined, the over 50s and upwards, not just those over 80.

She can hear the fear in the voices of family members she talks to on the phone. Families ask her what they should expect for their loved ones but she says she often feels she doesn't have the experience to give them an accurate picture of what will happen next.

COVID has also changed the relationship she has with her patients. Working in intensive care normally means caring for patients that are too sick to communicate. COVID is different though, patients entering the unit can talk.

"Some of them tell me they're scared," Pilipow says. "I get to know them, and that's very difficult.... They can often only speak in four or five word sentences before they have to stop and catch their breath," she adds.

Patients that enter the unit are very sick, and are very weak, "all of their energy is being used on their capacity to breathe.”

Once in the intensive care unit, staff will spend a couple of days trying to do everything possible to avoid having to put a person on a ventilator, as doing so comes with complications and risks. It's a small window where nurses get to talk and connect with their patients.

Once a patient has been intubated and placed on a ventilator they could be on it for up to three weeks.

"It takes a long time to get better, it's a very slow process of recovery," Pilipow says.

And some don't recover.

“They don’t die quickly, they fail to get better.”

Pilipow says they've had deaths, but she won't talk numbers. And again, she says the deaths feel different.

"It's always difficult when a patient dies under your care, but this is especially difficult because," she pauses for a long time to think. "I don't know what makes this more difficult, I don't want anyone to die under my care, maybe it's because we're seeing so much of the same.”

The pandemic has changed so many things in our society, even the way a professional critical care nurse deals with death.

Up to Jan. 6 the Northern Health region has recorded 2,274 cases of COVID-19 and 32 deaths. 

One thing is evident, being on the front line working in a unit dealing with the sickest people affected in the midst of a worldwide pandemic is physically and mentally exhausting.

Pilipow says she's conscious of compassion fatigue. It’s an issue health care workers faced prior to the pandemic.

Anyone who has spent time in a hospital bed can see how hard nurses work and Pilipow is no stranger to long hours and the emotional and physical toll the job can have on a person. But the pandemic has amplified that fatigue.

While the intensive care unit is not at full capacity, patients are being transferred from elsewhere in the province – which is not unusual for the small hospital – and it is incredibly busy.

"We're still capable of caring for patients, but I worry about my colleagues, (and) I worry how much longer can we do this before we're simply burnt out," she said.

Adding to this burnout is the fear and anxiety the deadly virus creates.

“There is definitely a lot of fear around me,” she says. “A lot of people are concerned about taking it home with them.”

But the coronavirus is taking its toll.

“I recently had a panic attack at work and that's not like me, I'm normally a very calm person,” she said.

She’s trying to take care of herself more.

She stopped working overtime, started using her days off to reset, trying to spend time outside, walking her dogs and going snowboarding.

And is she worried about catching COVID-19 herself?

She was in the beginning, but the fear has dwindled.

“After two months of caring for nothing but COVID patients I've learnt to trust in the PPE,” she said.

She’s also just had her first shot of the Moderna vaccine. When the time comes, she encourages everyone to get it.

Does she get frustrated by the anti-maskers and those who say it is just the flu?

“It doesn’t frustrate me that much,” she says calmly.

She's remarkably nonchalant about the fact she works 12-hour shifts caring for some of the sickest people in society while others spend their time protesting outside shopping malls over their “right” not to wear a mask.

But she does want to share the reality of working on the frontline to let people know that she recognizes that people are making sacrifices and that they are tired of the restrictions.

“I wanted people to know that we need them to be careful for a little while yet, because our health system is (nearing) capacity, and this is a real issue, this is really happening, (and) if we value healthcare in our society, people need to continue to be really careful,” she says. “I know that this is a reality that I'm working with right now, and I felt compelled to share my reality.”

And how does she feel about being at the forefront in a moment in history?

“I'm grateful for my job and that I can care for people, basically at this moment, one of their worst moments. It’s a privilege to be welcomed to care for somebody especially when their family can’t be there to help them,” she says. “It’s rewarding for sure.”

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